Seeinstructions): In the U.S., over 90,000 people are waiting for a donor organ, and each month the number rises. As the gap between needed and available organs widens, wait times increase. The wait is a period of worsening health, high stress and poor quality of life. Symptoms of anxiety, depression and insomnia are common. Pharmacologic therapies for symptom management intensify ongoing treatment regimens and increase risks of side effects and non-adherence. A promising alternative is Mindfulness-Based Stress Reduction (MBSR), a program of training in mindfulness meditation developed to facilitate adaptation to the stressors of chronic illness. Mindfulness skills adopted by candidates will have application preparing for and recovering from the stressors of transplant surgery, and for lifelong, post-transplant self-management. Our long-range goal is to develop evidence-based recommendations for safe, accessible, cost-effective non-pharmacologic strategies to reduce symptom distress and enhance the health-related quality of life (HRQL) of transplant patients. Specific aims are to determine the efficacy of a novel MBSR program delivery format to reduce symptoms of anxiety, depression and insomnia and improve HRQL before and after kidney transplantation. Candidates (N=60) will be stratified by dialysis status, and within strata randomized in equal numbers to: 1) an 8-wk MBSR program consisting of a Vz day workshop, 6-weekly teleconferences, Yz day retreat and a low dose home practice schedule; or 2) a support group (SG) attention control arm. Symptoms and HRQL measured by well-validated scales will be evaluated at baseline, 8-wks and 6-mos pre-transplant, and 2-, 6- and 12- mos post-transplant. Impact of MBSR on objective indicators - actigraphy and diurnal salivary cortisols - will be evaluated. Given the costs of transplantation, preparing candidates for successful surgeries and to derive full benefit out of the years of life gained post-transplant is a significant public health issue. This study will form the foundation for a full-scale, multi-site RCT of the cost-effectiveness of MBSR in this population. MBSR is a low-cost, low-risk intervention that, if successful, could be replicated easily and result in important reductions in health care costs while improving the lives of transplant patients. RELEVANCE (See instructions): This study will determine if patients waiting for a donor kidney will benefit from Mindfulness-Based Stress Reduction, a program designed to facilitate adaptation to the stresses of medical illness. MBSR is a low-cost, low-risk intervention that, if successful, could be integrated into transplant care and result in important reductions in health care costs while improving the lives of transplant patients.